Editing Cachexia (section)

==Treatment==

Because cachexia is a complex condition with several potential causes, treatment requires multiple approaches at the same time.<ref name="sadeghi-2018" /> The best strategy is to treat the cause of the cachexia, if known.<ref name="ferrer-2023" /><ref name=Care-2009>{{cite web|title=Care Management Guidelines Fatigue, Anorexia and Cachexia|url=http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0006/36942/Fatigue_Anorexia_Cachexia_Final290909_PCSSubComm.pdf|access-date=23 February 2014|archive-url=https://web.archive.org/web/20140514022343/http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0006/36942/Fatigue_Anorexia_Cachexia_Final290909_PCSSubComm.pdf|archive-date=2014-05-14|url-status=dead}}</ref> For example, people with cachexia caused by AIDS often improve after starting treatment for AIDS.<ref>{{Cite web|url=https://www.webmd.com/hiv-aids/guide/aids-wasting-syndrome|title=AIDS Wasting Syndrome|website=WebMD}}</ref> However, because the exact mechanism of cachexia is unclear, there is no single medication that can effectively treat it.<ref name="setiawan-2023" /> Instead, treatment focuses on a combination of exercise, nutrition, medications, and psychosocial support.<ref name="setiawan-2023" />

===Exercise===

Regular physical exercise is recommended for the treatment of cachexia because of its positive effects on muscle function.<ref name="setiawan-2023" />  Exercise can reduce protein breakdown, improve muscle strength, decrease inflammation, and enhance metabolism.<ref name="setiawan-2023" /> However, its effectiveness in cancer patients - especially those who are frail or have sarcopenia - remains uncertain.<ref name="setiawan-2023" /><ref name="pmid33735441">{{cite journal | vauthors = Grande AJ, Silva V, Sawaris Neto L, Teixeira Basmage JP, Peccin MS, Maddocks M | title = Exercise for cancer cachexia in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 3| pages = CD010804 | date = March 2021 | pmid = 33735441 | doi = 10.1002/14651858.CD010804.pub3|pmc=8094916 }}</ref>  Many people with cachexia also avoid exercise because they lack motivation or fear that it will worsen their symptoms.<ref name="pmid28758698">{{cite journal | vauthors = Wasley D, Gale N, Roberts S, Backx K, Nelson A, van Deursen R, Byrne A | title = Patients with established cancer cachexia lack the motivation and self-efficacy to undertake regular structured exercise | journal = Psycho-Oncology | volume = 27 | issue = 2 | pages = 458–464 | date = February 2018 | pmid = 28758698 | doi = 10.1002/pon.4512 | s2cid = 206378678 | url = http://orca.cf.ac.uk/103309/1/Structured%20exercise%20and%20patients%20with%20cancer%20cachexia%20main%20document%20with%20bold%20revisions%20final17.pdf | hdl = 10369/8759 | hdl-access = free }}</ref>

===Nutrition===
Cachexia can increase metabolism and suppress appetite, worsening the present muscle loss.<ref name="argiles-2016" /> Studies show that high-calorie, protein-rich diets may help stabilize weight, though they do not necessarily improve muscle mass.<ref name="Kumar">{{cite journal | vauthors = Kumar NB, Kazi A, Smith T, Crocker T, Yu D, Reich RR, Reddy K, Hastings S, Exterman M, Balducci L, Dalton K, Bepler G | title = Cancer cachexia: traditional therapies and novel molecular mechanism-based approaches to treatment | journal = Current Treatment Options in Oncology | volume = 11 | issue = 3–4 | pages = 107–17 | date = December 2010 | pmid = 21128029 | pmc = 3016925 | doi = 10.1007/s11864-010-0127-z }}</ref> Current recommendations include 1.5g/kg/day of protein, making up 15-20% of daily calories.<ref name="setiawan-2023" /> However, feeding tubes ([[enteral nutrition]]) should not be used routinely.<ref>{{Cite journal |last=Roeland |first=Eric J. |last2=Bohlke |first2=Kari |last3=Baracos |first3=Vickie E. |last4=Bruera |first4=Eduardo |last5=del Fabbro |first5=Egidio |last6=Dixon |first6=Suzanne |last7=Fallon |first7=Marie |last8=Herrstedt |first8=Jørn |last9=Lau |first9=Harold |last10=Platek |first10=Mary |last11=Rugo |first11=Hope S. |last12=Schnipper |first12=Hester H. |last13=Smith |first13=Thomas J. |last14=Tan |first14=Winston |last15=Loprinzi |first15=Charles L. |date=2020-07-20 |title=Management of Cancer Cachexia: ASCO Guideline |url=https://ascopubs.org/doi/10.1200/JCO.20.00611 |journal=Journal of Clinical Oncology |language=en |volume=38 |issue=21 |pages=2438–2453 |doi=10.1200/JCO.20.00611 |issn=0732-183X}}</ref>

===Medications===
Some medications, such as [[glucocorticoid]]s, [[cannabinoid]]s, and [[progestin]]s were initially used in treating cachexia and aim to increase appetite.<ref name="setiawan-2023" /> Progestins showed promise initially, but they do not stop muscle wasting and may cause fluid retention, fat gain, and other side effects.<ref name="sadeghi-2018" /><ref name="peterson-2017" /><ref name="setiawan-2023" /><ref name="epcrc-2010" />

Ghrelin agonists, such as [[Anamorelin]] are commonly used in cancer treatment to boost appetite, increase weight, and increase muscle mass.<ref name="setiawan-2023" /> However, its use and effectiveness in cachexia is not well studied.

Selective androgen receptor modulators (SARMs) such as Enobosarm show promise in increasing physical performance and muscle mass, but more studies are needed to confirm their effectiveness in cachexia.<ref name="sadeghi-2018" />

The use of anti-inflammatory medications have been investigated. [[Thalidomide]], an anti-inflammatory agent, has shown promise in preventing weight loss, but the use of this medication in cachexia is not widely accepted.<ref name="sadeghi-2018" /><ref>{{cite journal |vauthors=Reid J, Mills M, Cantwell M, Cardwell CR, Murray LJ, Donnelly M |date=April 2012 |title=Thalidomide for managing cancer cachexia |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=4 |pages=CD008664 |doi=10.1002/14651858.cd008664.pub2 |pmc=6353113 |pmid=22513961}}</ref> However, other TNF inhibitors have not shown the same promising results.<ref name="setiawan-2023" /> [[Nonsteroidal anti-inflammatory drug|NSAIDs]] such as celecoxib and ibuprofen showed some early benefits, but side effects (renal injury, GI bleeding) limit their use.<ref name="sadeghi-2018" />

Anti-nausea drugs such as [[5-HT3 antagonist|5-HT<sub>3</sub> antagonists]] are also commonly used if nausea is a prominent symptom.<ref name="Kumar" />

[[Anabolic-androgenic steroid|Anabolic steroid]]s like [[oxandrolone]] may help but are only recommended for short term use due to [[side effect]]s including liver toxicity.<ref name="sadeghi-2018" /><ref name="epcrc-2010" /><ref name="Mantovani2007">{{cite book |author=Giovanni Mantovani |url=https://books.google.com/books?id=lQyGxrmQ17AC&pg=PA673 |title=Cachexia and Wasting: A Modern Approach |date=6 October 2007 |publisher=Springer Science & Business Media |isbn=978-88-470-0552-5 |pages=673–}}</ref>

=== Supplements ===
The use of certain amino acids may slow muscle breakdown by providing the body with the building blocks needed for metabolism of muscle and glucose. Specifically, [[leucine]] and [[valine]] may block muscle breakdown.<ref>{{cite journal | vauthors = Eley HL, Russell ST, Tisdale MJ | title = Effect of branched-chain amino acids on muscle atrophy in cancer cachexia | journal = The Biochemical Journal | volume = 407 | issue = 1 | pages = 113–20 | date = October 2007 | pmid = 17623010 | pmc = 2267397 | doi = 10.1042/BJ20070651 }}</ref> [[Glutamine]] is used in oral supplements for people with advanced cancer<ref name="May">{{cite journal | vauthors = May PE, Barber A, D'Olimpio JT, Hourihane A, Abumrad NN |author5-link=Naji Abumrad | title = Reversal of cancer-related wasting using oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine | journal = American Journal of Surgery | volume = 183 | issue = 4 | pages = 471–9 | date = April 2002 | pmid = 11975938 | doi = 10.1016/s0002-9610(02)00823-1 }}</ref> or [[HIV/AIDS]].<ref name="WebMD">{{cite web|title=Glutamine|url=http://www.webmd.com/vitamins-supplements/ingredientmono-878-glutamine.aspx?activeingredientid=878&activeingredientname=glutamine|website=WebMD|publisher=WebMD, LLC|access-date=2015-03-15}}</ref>

[[β-hydroxy β-methylbutyrate]] (HMB) is a molecule that comes from leucine that promotes muscle growth. Studies show positive results for chronic pulmonary disease, hip fracture, and in AIDS-related and cancer-related cachexia. However, it is often studied along with other nutrients, making it difficult to assess its effects alone.<ref>{{cite journal | vauthors = Brioche T, Pagano AF, Py G, Chopard A | title = Muscle wasting and aging: Experimental models, fatty infiltrations, and prevention | journal = Molecular Aspects of Medicine | volume = 50 | pages = 56–87 | date = August 2016 | pmid = 27106402 | doi = 10.1016/j.mam.2016.04.006 | s2cid = 29717535 | url = https://hal.archives-ouvertes.fr/hal-01837630/file/2016_Brioche_MAM_1.pdf }}</ref><ref>{{cite journal | vauthors = Holeček M | title = Beta-hydroxy-beta-methylbutyrate supplementation and skeletal muscle in healthy and muscle-wasting conditions | journal = Journal of Cachexia, Sarcopenia and Muscle | volume = 8 | issue = 4 | pages = 529–541 | date = August 2017 | pmid = 28493406 | pmc = 5566641 | doi = 10.1002/jcsm.12208 }}</ref>

[[Creatine]] supplementation may help reduce muscle wasting, though more research is needed.<ref>{{cite journal | vauthors = Lulu W, Ranran W, Kai L, Xiaolu J, Li L | title = Creatine modulates cellular energy metabolism and protects against cancer cachexia-associated muscle wasting | journal = Frontiers in Pharmacology | date = 7 December 2022  | volume = 13 | pmid = 36569317 | doi = 10.3389/fphar.2022.1086662 | doi-access = free | pmc = 9767983 }}</ref>